gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Intramedullary astrocytoma and ependymoma – surgical results and clinical outcome

Intramedulläre Astrozytome und Ependymome – Chirurgische und klinische Ergebnisse

Meeting Abstract

  • corresponding author C. Erös - Neurochirurgische Klinik, Ludwig-Maximilians-Universität München
  • S. Zausinger - Neurochirurgische Klinik, Ludwig-Maximilians-Universität München
  • E. Uhl - Neurochirurgische Klinik, Ludwig-Maximilians-Universität München
  • J.-C. Tonn - Neurochirurgische Klinik, Ludwig-Maximilians-Universität München
  • R. Goldbrunner - Neurochirurgische Klinik, Ludwig-Maximilians-Universität München

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSO.04.04

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter:

Veröffentlicht: 11. April 2007

© 2007 Erös et al.
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Objective: Clinical outcomes of patients with intramedullary tumors seem to depend on histology and extent of surgical resection. The aim of our study was to assess surgical results and the neurological outcome of these patients.

Methods: A total of 43 tumor resections was performed in 38 patients (27 ependymoma, 7 astrocytoma WHO °I, 4 astrozytoma WHO °II) between 1/2002 and 5/2006 under intraoperative electrophysiological monitoring, 29 in the ependymoma and 14 in the astrocytoma group. For ependymomas, mean tumor extension was 2.9 levels (range 1-10), in astrocytomas 3.7 levels (range 1-9). In case of multilevel approaches, we performed a laminoplasty with refixation of the incised lamina(e). Routine intraoperative ultrasound and postoperative MRT was done to evaluate complete tumor removal. Clinical outcome using the McCormick scale (McC 0, no deficit – 5, completely dependent) was assessed before operation, one week and 6 months after surgery.

Results: Complete tumor removal was achieved in 22/29 ependymomas and in 6/14 astocytomas, 76% and 43%, respectively. Recurrent tumor growth during follow-up (range 6 - 40 months) was noted in 2 astrocytoma patients and no ependymoma patient. Ependymoma patients showed an improvement of neurological function during follow-up: Median McC improved from 2 (95%CI: 0.29) to 1 (0.38) after 1 week and 1 (0.40) after 6 months. In astrocytomas, in only 4/14 cases patients (McC 1-2) improved slightly. However, McC scores remained unchanged: 2 (0.36) preoperatively, 2 (0.39) and 2 (0.43) postoperatively. No neurological deterioration was seen in these patients.

Conclusions: In contrast to generally high resection rates and encouraging outcomes in ependymomas, favourable neurological outcomes in astrocytomas are achieved only by (1) using cautious intraoperatibe strategies (2) in patients with good preoperative McC. Therefore, early admission for surgery instead of watchful waiting should be the strategy in these patients.